Intratemporal Facial Nerve Schwannomas: A Review of 45 Cases in A Single Center

Abstract

There are no established indications for facial nerve schwannoma treatment, including surgery, radiation and follow-up observation, and it is difficult to determine treatment policy uniformly. The treatment policy was examined from each treatment course. Data of patients with facial nerve schwannomas at our hospital from 1987 to 2018 were retrospectively examined. Their age, sex, clinical symptoms, tumor localization, treatment policies and outcomes were reviewed. In total, 22 patients underwent surgery and 1 patient underwent radiotherapy; 22 patients were followed up without treatment. After total resection, there were no tumor recurrences, and most patients had grade 3 or 4 postoperative facial paralysis. After subtotal resection, tumor regrowth was observed in four patients and reoperation was required in two patients. Facial nerve function was maintained in four patients and was decreased in two patients. During follow-up, six patients showed tumor growth. Only one patient had worsening facial nerve paralysis; four patients underwent facial nerve decompression owing to facial nerve paralysis during follow-up. If the tumor compresses the brain or it is prone to growth, surgery may be indicated, and when the preoperative facial nerve function is grade ≤3, consideration should be given to preserving facial nerve function and subtotal resection should be indicated. If the preoperative facial nerve function is grade ≥3, total resection with nerve grafting is an option to prevent regrowth. If there is no brain compression or tumor growth, the follow-up is a good indication, and decompression should be considered in facial nerve paralysis cases.

Facial nerve schwannoma and other benign neoplastic facial nerve lesions

“…It should also be noted that a certain percentage of tumors do not grow without intervention. Although several studies have reported treatment timing [8,9 ▪ ], no established standard for treatment selection integrates each perspective.…”

“…If there is no compression of the brain or a tendency for tumor growth, a wait-and-scan approach is a good option. When facial nerve paralysis occurs during follow-up observation, steroids and decompression should be considered to prevent worsening of facial nerve paralysis [9 ▪ ].…”

“…Treatment policies for facial nerve schwannoma. A representative treatment strategy for facial nerve schwannomas is described [9 ▪ ]. Treatment strategies for facial nerve schwannomas are divided according to whether the tumor compresses the brain.…”

“…Surgical interventions were divided into total and subtotal resections. Subtotal resection should be indicated to preserve facial nerve function, especially for cases with preoperative House–Brackmann grade III or less [9 ▪ ]. If facial nerve function is worse than House–Brackmann grade IV, total resection with nerve grafting may be an option for preventing regrowth.…”

A new gene for autosomal dominant facial palsy/migraine identified in a family by whole exome sequencing

“…Virus or bacterial infection is the second most common ethology of palsy like Ramsay Hunt syndrome associated with a varicella zoster infection or Lyme disease associated with the bacterium Borrelia burgdorferi [3,4]. A progressive onset of facial palsy should raise suspicion of malignancy; acoustic or facial nerve neurinoma, meningioma, parotid tumours and schwannoma should be considered [5,6].…”